Provider Demographics
NPI:1902839194
Name:MARK SACK DPM PC
Entity Type:Organization
Organization Name:MARK SACK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-238-7270
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-1262
Mailing Address - Country:US
Mailing Address - Phone:773-238-7270
Mailing Address - Fax:773-238-9627
Practice Address - Street 1:3216 W 115TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2805
Practice Address - Country:US
Practice Address - Phone:773-238-7270
Practice Address - Fax:773-238-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633481OtherBCBS
ILDE0221OtherRAILROAD MEDICARE
IL208770Medicare PIN